Infective Endocarditis

Question 1

What do oral strep use to adhere to NBTE?
What is NBTE?
What are most oral strep?

Answer 1

Dextran
Nonbacterial thrombotic endocarditis
Viridans strep

Question 2

Complications of IE

Answer 2

Heart murmur, CHF, emobli –> strokes / infarcts, fistula b/w heart chambers, pericarditis, bacteremia, immune complexes. abscesses, vertebral osteomyelitis

Question 3

Complications of bacteremia

Answer 3

Sepsis, mycotic aneurysm (due to destruction of tunica media), meningitis, abscess, osteomyelitis, septic arthritis

Question 4

Which valve is highest risk for embolization?

Answer 4

Mitral

Question 5

Cardiac risk factors

Answer 5

Rheumatic heart disease, congenital heart / valve disease, degenerative valve disease (age), prosthetic valve

Question 6

Complications of immune-overactivity

Answer 6

Hypergammaglobulinemia, splenomegaly, immune complexes (glomerulunephritis, Osler’s nodes, vasculitis, arthralgia / myalgia)

Question 7

Osler’s nodes

Answer 7

Painful, red, raised lesions on hands / feet

Question 8

Clinical signs

Answer 8

Murmur
Splinter hemorrhage - infarct in finger nail
Janeway’s Lesion - painless, flat infarcts on palms / soles
Roth’s spots - retinal hemorrhage
Conjunctival hemorrhage
Osler’s Nodes
Petechial rash - most common skin finding
Splenomegaly

Question 9

Labs

Answer 9

3 sets of blood cultures from 2 diff parts of body
ESR - measure of inflammation
Immunologic tests may show positive ANA, rheumatoid factor, or low complement

Question 10

Common portals of infection and organisms

Answer 10

• Oral source: Recent dental procedures or poor dentition. Portal for viridans strep
• GI tract: Bleeding, pain, diarrhea, change in bowel habits. Often involves Enterococci or Streptococci.
• GU tract: UTI symptoms, bleeding, procedures. Often involves Enterococci or Gram-negative anaerobes.
• Skin and soft tissue: Cuts, boils, infections. Portal for Staph aureus and Staph epidermidis.
• IV catheters: portal for Staph and Candida

Question 11

ABE vs SBE
Which has prior valve disease more often?
Which has murmur more often?
Which has splenomegaly more often?
Which has larger vegetations?
Which needs surgery more often?
Which has emboli more often?
Which has immunologic complications more often?

Answer 11

Prior valve disease: subacute
Murmur: subacute
Splenomegaly: subacute
Vegetaions: acute
Surgery: acute
Emboli: acute
Immunologic complications: subacute

Question 12

Which valve most often affected from IV drug use?

Answer 12

Tricuspid

Question 13

What 2 organisms cause 80% of IE?

Answer 13

Strep and Staph

Question 14

Causes of SBE

Answer 14

Viridans strep (most common)
Enterococci
Staph aureus

Question 15

Causes of ABE

Answer 15

Staph aureus
GAS
GBS
Pneumococcus
Gram neg bacilli

Question 16

What is most common cause of IE?

Answer 16

Staph aureus

Question 17

What is most common cause of SBE?

Answer 17

Viridans strep

Question 18

Treatment for Strep

Answer 18

IV penicillin or IV ceftriaxone. Add gentamicin if MIC is high.

Question 19

What types of IE involve gram-neg bacilli?

Specific organisms

Answer 19

PVE and drug use

Pseudomonas aeruginosa, Klebsiella, Salmonella

Question 20

HACEK
General description
Specific types

Answer 20

Fastidious Gram-negative organisms
•Haemophilus spp 
•Actinobacillus 
•Cardiobacterium 
•Eikenella 
•Kingella spp

Question 21

What types of IE involve Candidia?

Answer 21

Catheter IV, drug IV, PVE

Question 22

Indications for surgery

Answer 22

CHF, uncontrolled infection, multiple emboli, AB resistance

Question 23

Indications for AB prophylaxis

Answer 23

Dental work, prosthetic heart valve, prior endocarditis, CHD, post-cardiac transplant

Question 24

What is #1 risk for endocarditis?

Answer 24

having had it in the past